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首页> 外文期刊>Journal of Medical Microbiology: An Official Journal of the Pathological Society of Great Britain and Ireland >Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study
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Increasingly limited options for the treatment of enteric fever in travellers returning to England, 2014–2019: a cross-sectional analytical study

机译：越来越有限的选择肠胃发烧的肠胃发烧，回到英格兰，2014-2019：横断面分析研究

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Introduction Enteric fever (caused by Salmonella enterica serovars Typhi and Paratyphi) frequently presents as an acute, undifferentiated febrile illness in returning travellers, requiring timely empirical antibiotics. Gap statement Determining which empirical antibiotics to prescribe for enteric fever requires up-to-date knowledge of susceptibility patterns. Aim By characterising factors associated with antimicrobial resistance in cases of S . Typhi and S . Paratyphi imported to England, we aim to guide effective empirical treatment. Methodology All English isolates of S . Typhi and S . Paratyphi 2014–2019 underwent antimicrobial susceptibility testing; results were compared to a previous survey in London 2005–2012. Risk factors for antimicrobial resistance were analysed with logistic regression models to predict adjusted odds ratios (aOR) for resistance to individual antibiotics and multi-drug resistance. Results We identified 1088?cases of S . Typhi, 729? S . Paratyphi A, 93? S . Paratyphi B, and one S . Paratyphi C. In total, 93?% were imported. Overall, 90?% of S . Typhi and 97?% of S . Paratyphi A isolates were resistant to ciprofloxacin; 26?% of S . Typhi were multidrug resistant to ciprofloxacin, amoxicillin, co-trimoxazole, and chloramphenicol (MDR+FQ). Of the isolates, 4?% of S . Typhi showed an extended drug resistance (XDR) phenotype of MDR+FQ?plus resistance to third-generation cephalosporins, with cases of XDR rising sharply in recent years (none before 2017, one in 2017, six in 2018, 32 in 2019). For S . Typhi isolates, resistance to ciprofloxacin was associated with travel to Pakistan (aOR=32.0, 95?%?CI: 15.4–66.4), India (aOR=21.8, 95?%?CI: 11.6–41.2), and Bangladesh (aOR=6.2, 95?%?CI: 2.8–13.6) compared to travel elsewhere, after adjusting for rising prevalence of resistance over time. MDR+FQ resistance in S . Typhi isolates was associated with travel to Pakistan (aOR=3.5, 95?%?CI: 2.4–5.2) and less likely with travel to India (aOR=0.07, 95?%?CI 0.04–0.15) compared to travel elsewhere. All XDR cases were imported from Pakistan. No isolate was resistant to azithromycin. Comparison with the 2005–2012 London survey indicates substantial increases in the prevalence of resistance of S . Typhi isolates to ciprofloxacin associated with travel to Pakistan (from 79–98?%) and Africa (from 12–60?%). Conclusion Third-generation cephalosporins and azithromycin remain appropriate choices for empirical treatment of enteric fever in most returning travellers to the UK from endemic countries, except from Pakistan, where XDR represents a significant risk.
机译：引入肠溶发烧（由沙门氏菌肠道塞洛维拉Typhi和Paratyphi引起的）经常呈现为恢复旅行者的急性，未分化的发热疾病，需要及时验证抗生素。差距陈述确定规定肠溶发热的经验抗生素需要最新了解易感模式。旨在表征与患者抗微生物抗性相关的因素。 Typhi和s。 Paratyphi进口到英格兰，我们的目标是指导有效的实证治疗。方法的所有英语分离株S. Typhi和s。 Paratyphi 2014-2019经过抗菌易感性测试;将结果与2005 - 2012年伦敦上一项调查进行了比较。用逻辑回归模型分析抗微生物抗性的危险因素，以预测调整后的抗生素（AOR）对个体抗生素和多种耐药性的影响。结果我们确定了1088年的案例。 Typhi，729？ s。 Paratyphi A，93？ s。 Paratyphi B和一个s。帕拉伐木C.总共进口了93倍。总体而言，90？％s。 Typhi和97？％s。帕拉伐氏菌分离株对环丙沙星耐药; 26？％s。 Typhi对环丙沙星，阿莫西林，共氮氧唑和氯霉素（MDR + FQ）进行多药抗性。分离物，4？％s。 Typhi显示了MDR +FQα的扩展耐药性（XDR）表型，近年来XDR急剧上升的情况急促（2017年之前，2018年的六年，2019年32次）。对于s。 Typhi分离物，对Ciphofloxacin的抗性与Pakistan的旅行有关（AOR = 32.0,95？％？CI：15.4-66.4），印度（AOR = 21.8,95？％？CI：11.6-41.2）和孟加拉国（AOR = 6.2,95？％？CI：2.8-13.6）与其他地方的旅行相比，调整耐时性升高的普遍性之后。 MDR + FQ电阻在s中。 Typhi孤立与前往巴基斯坦的旅行有关（AOR = 3.5,95？％？CI：2.4-5.2），而且对印度的旅行不太可能（AOR = 0.07,95？％？CI 0.04-0.15）。所有XDR病例都从巴基斯坦进口。没有孤立对阿奇霉素的抗性。与2005-2012伦敦调查的比较表明患者抗性普遍性的大幅增加。 Typhi与旅行到巴基斯坦（79-98？％）和非洲（从12-60？％）相关联的西普洛昔林。 Conclusion Third-generation cephalosporins and azithromycin remain appropriate choices for empirical treatment of enteric fever in most returning travellers to the UK from endemic countries, except from Pakistan, where XDR represents a significant risk.

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